It was a day like any other in the outpatient psychiatric clinic. I checked my schedule and made my way to the lobby to get my next patient. “Lisa?” I called. A 30 something-year-old white female got up and walked towards me. Her gaze was at her feet but her face showed she was distraught, as if she bore a secret that was burning her inside. Alongside her rose her caseworker, Laura, a middle-aged white woman who always had a calm, nurturing, and warm smile. “How are you doing today?” I asked. She mumbled in reply.
As she walked into my office, Lisa dropped her backpack like a sack of potatoes, threw herself into the chair in front of me, and started to unleash her frustrations. “She voted for Trump and I can’t work with her anymore!” she said. I sat confused and staring Laura, who was sitting opposite Lisa, in search of some explanation. Lisa continued, “She voted for Trump and it’s like she voted against me! I’m on social security! I live in section 8 housing! I need food stamps to eat!” All this while Lisa was glaring at Laura with a look of hatred and mistrust. “Lisa, I don’t think you have anything to worry about,” Laura chimed, with almost a smirk on her face. “You’re overreacting,” Laura continued. This angered Lisa even more. “Do you think it’s not gonna affect you? If anyone is gonna lose their jobs, it’s not gonna be the doctor or the nurse, it’s gonna be the other staff like you!” Lisa said.
I felt helpless, but I knew I had to intervene. I asked them both to take a metaphorical step back. “Lisa, did you like working with Laura before the election?” “Yes.” “Do you think she did what she was supposed to to help you?” “Well, yea.” “Then, I don’t think that has to change. Maybe you guys shouldn’t talk about politics anymore, though.” Lisa looked at me. “Doesn’t it make you angry?” I wasn’t expecting the question. I’m essentially a unicorn: a Black female physician, born of immigrant parents, who identifies as queer, and in a heterosexual interracial marriage. You can basically guess my political leanings and, the truth is, I felt uncomfortable whenever anyone mentioned the election. “I know that Laura has always been responsible and respectful of me and other patients, regardless of her political leanings, and it makes my day easier if I think about that,” I said… and I meant it.
The thing is, there’s no escaping social issues in medicine. Unfortunately, this isn’t emphasized in medical school. During my first 2 years, like most others, I spent all my time learning every inch of the human body and all the ways it could succumb to illness. Even in my clinical years, looking back, I feel like none of my preceptors had or took the time to guide my gaze past the hospital corridors and exam rooms to the world in which our patients lived. I found a way to disconnect my personal struggles (obtaining healthcare, juggling student loan debt, remaining a source of emotional support for my family) from the everyday struggles of those I hoped to treat. The extent of my cognitive dissonance still perplexes me.
You have to stay informed.
Mental health professionals, in my opinion, have to spend more time considering psychosocial stressors because of the obvious implications, but it affects all areas of medicine. From school resources for disabled children (504 plans and IEPs), housing (section 8 voucher programs, homeless shelters, transitional housing, rehabilitation treatments centers, domestic violence shelters), access to food (food stamps and WIC), to economic aid (social security disability income and veterans assistance) and access to medical care (Medicaid, Medicare, and Rx aid programs); there are multiple factors to be considered to provide comprehensive healthcare. If you want to do more than blindly write prescriptions and perform procedures with the intent of a robot, you have to stay informed. The truth is that if you’re affiliated with any hospital system, which most of us are these days, you have no choice. People who do not receive adequate and comprehensive care during initial visits decompensate and end up right back where they started. This is costly and part of the reason why I think healthcare costs continue to rise.
Process your thoughts and feelings.
You’d be lying to yourself if you said that you don’t have personal opinions about social and economic policy. It’s normal, encouraged, and part of your duty as a human being. Be honest with yourself about your opinions. Discuss them with those you trust. The biggest mistake I feel people make is to deny their feelings and convictions because they don’t want to be perceived a certain way. It’s best to know your personal “triggers” (something that sets off a memory of an emotional stance or event) before being confronted by them at work. Personally, I’m as liberal as you can possibly get. You can probably insert any social welfare reform or political policy in a sentence and end it with “Nora agrees” and be correct in your assumption. I know this about myself, having spent hours discussing the pros and cons with friends and family that I trust, and I feel like I’m in a position to handle maneuvering such topics at work.
Remember the 4 basic moral principles of medicine: Autonomy, Beneficence, Non-maleficence, and Justice.
When you graduated from medical school, you took an oath to serve. I wholeheartedly believe that personal convictions have no place in a healthcare setting. It absolutely shocks me to hear that a patient in need would be turned away from a practitioner because of misaligned personal beliefs. Put yourself in the shoes of another: would you want someone to refuse to care for you because of your religion, skin color, or political leanings? Imagine being in a state of desperation, all fingers pointing you towards a medical professional as your savior.
In my short career I’ve learned that, to excel as a physician, you have to do more than be able to regurgitate information. Be an example of comprehensive understanding, cohesion, and humility.
Besides, if you don’t, I can almost guarantee your satisfaction ratings will reflect it.
*Names were changed to protect the identity of those in the above story.*